By Carl V. Leier MD, FACP (auth.), Juan Bowen M.D., Ernest L. Mazzaferri M.D. (eds.)
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Additional info for Contemporary Internal Medicine: Clinical Case Studies
Until recently, it developed in over 80 percent of AIDS patients, but widespread PCP prophylaxis has changed this. 26 The patient under discussion had a very typical clinical picture of this infection. PCP's onset may be gradual, with weeks of fever, exertional dyspnea, and dry cough. There is high fever, tachypnea, and occasionally rales. Most commonly, hypoxia is present and worsens with exertion. The chest roentgenogram usually shows a diffuse interstitial pneumonia, but may show consolidation or cysts, and in 10 percent of cases is normal.
Multiple therapeutic modalities, including zidovudine, may be efficacious, if spontaneous remission does not occur. 22 Indicators of Progression. Impaired immunologic function with clinical progression from ARC to an AIDS-defining opportunistic infection (or malignancy) occurs slowly and at an unpredictable rate. Because of the long latency period, the time for progression from initial HIV infection to AIDS remains uncertain. Homosexual men studied in San Francisco show a 36 percent incidence of AIDS seven years after initial HIV infection.
Although more than 98 percent with gouty arthritis have hyperuricemia at some time in their clinical course, about 10 percent of patients with rheumatoid arthritis also have hyperuricemia. 4 ,18 To confirm a diagnosis of rheumatoid arthritis it is· sometimes necessary to demonstrate that a subcutaneous nodule has the pallisading and necrobiotic center characteristic of a rheumatoid nodule. Coexistent Gout and RheumatoidArthritis. The possibility of coexistent gout and rheumatoid arthritis might be raised in our patient.